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Comparative Billing Reports

CBR201804 Statistical Debriefing

CBR201804

The following is a description of the tables used in CBR201804 Critical Care Services. There are links that will open the excel files that contain state and national statistics used in the analysis of rendering Part B providers for CBR201804. All of the analyses in this Comparative Billing Report (CBR) include only the Current Procedural Terminology (CPT®) Codes 99291 and 99292. CBR201804 includes claims with dates of service from January 1, 2017 to December 31, 2017. These analyses are based on the latest version of claims available from the Integrated Data Repository as of April 12, 2018. Examples of each table can be found in the CBR201804 sample.

Table 1: Summary of Your Utilization for Critical Care E/M Services

Table 1 provides a summary of your utilization for the CPT® codes included in this CBR. The total allowed charges, allowed services, distinct visit count, and distinct beneficiary count are included for each CPT® code and modifier type, along with an overall total line. Below is an example of Table 1 from the CBR sample:

*A visit is defined as a unique date of service between a beneficiary and a provider

For this mock provider, the table indicates that he/she has total allowed charges of $93,711 for the two CPT® codes and modifier types included in the study. This mock provider has provided 419 critical care services to 183 beneficiaries.

Please note that the totals may not be equal to the sum of the rows due to rounding. Also, the visit and beneficiary counts are unduplicated counts for each row and the total. For example, a beneficiary receiving multiple services with different CPT® codes within this time period would be counted in the beneficiary count in each applicable row; however, this beneficiary would be counted only once in the total row.

Table 2: Percentage of Services Submitted with Modifier 25

Table 2 presents the percentage of critical care E/M allowed services submitted with modifier 25. The percentage is calculated for each individual rendering provider by multiplying the number of services with modifier 25, divided by the total number of services, then multiplying by 100.

This calculation covers only the CPT® codes included in this CBR. Each provider’s percentage is compared to his/her state and the nation using the chi-square test at the alpha value of 0.05. Below is an example of Table 2 for our mock provider.

In this example, the mock provider has rendered 68 services with modifier 25, out of a total of 419 services. Dividing 68 by 419, and multiplying by 100, yields his/her percentage of 16 percent. The state’s percentage is 9 percent, and the national percentage is 11 percent. The statistical test used in this analysis, chi-square test, shows this provider’s percentage as “Significantly Higher” than those of both the state and the nation.

It is important to note that the significance, determined by the statistical test, is based on not only the differences in the values, but also the number of observations and the variability of those observations. Generally, the higher the number of observations, the better the statistical test is able to detect significance.

Table 3: Average Number of Visits per Beneficiary

Table 3 shows the average number of critical care service dates, or visits per beneficiary for the one-year period. This average is calculated as the number of visits divided by the number of beneficiaries.

Each provider’s average is compared to his/her state and the nation using t-test at the alpha value of 0.05. Table 3 is an example of the results of this analysis.

Table 3: Mock Average Number of Visits per Beneficiary
Dates of Service: January 1, 2017 – December 31, 2017

Number of Visits

Number of Beneficiaries

Your Average

Your State’s Average

Comparison with Your State

National Average

Comparison with National Average

369

183

2.02

2.47

Does Not Exceed

1.98

Higher

A t-test was used in this analysis, alpha = 0.05

This mock provider has 369 visits included in this CBR for 183 beneficiaries. Dividing 369 by 183 beneficiaries yields the average number of visits per beneficiary of 2.02. The t-test indicates that this mock provider’s average “Does Not Exceed” that of the state, but is “Higher” than the national peer group.

Table 4: Average Allowed Charges per Beneficiary

Table 4 provides a statistical analysis of the average allowed charges per beneficiary for the one-year period. This average is calculated as total allowed charges divided by total number of beneficiaries.

Each provider’s average is compared to his/her state and the nation, using the t-test at the alpha value of 0.05. Table 4 is an example of the results of this analysis.

This mock provider has $93,711.14 for the critical care services included in this CBR covering 183 beneficiaries. Dividing $93,711.14 by 183 beneficiaries yields the average allowed charges per beneficiary of $512.08. The t-test indicates that this mock provider’s average “Does Not Exceed” that of the state, but is “Significantly Higher” than the national peer group.